| NPI | 1639635808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PR 4740) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: PR 1625) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2025-10-10 |